Thanatopraxie

The Thanatopraxie so called restorative art in Belgium is the term which indicates the modern methods of conservation the late ones. It seems to appear in France in the years 1960. It is a technique in full expansion: For approximately 400 care of conservation in France in 1963, these are approximately 100.000 thanatopraxies which would have been carried out in 2003 in this country. According to the highest figures, in the future years: 30% of the corpses would be treated each year, with very variable rates according to the areas and the populations concerned (urban, rural, of culture close to the traditions or not.).

Thanatopraxie can have various objectives: D-to humanize the corpse to facilitate mourning for its close relations, a setting on standby for lack of priests, pastors or because of waitings which lengthen with the Crématorium S, or finally for the conservation of a corpse intended to be transported towards a remote country.

In all the cases it is a question of temporarily limiting the natural process of putrefaction which is implemented normally as of death. The French-speaking people reserve more and more the term Embaumement with the practices of the Antiquité or care aiming at a conservation of long life (ex: the corpse of Lénine).

Origin of the word:

“Thanatopraxie” is a neologism which seems to be created about 1950, rising from the words “Thanatos” (θανατος, Greek Divinité of dead) and “prattein” (to treat). The word was creates about 1950 per André Chatillon to indicate this care aiming to the conservation of the body of late. Until the middle of the Sixties, they are doctors who practice the " embaumements".

Thanatopracteur

Thanatopraxie is carried out by a specialized technician, the Thanatopracteur, free lance or paid of a company dedicated to the thanatopraxie, the undertaking or the supply of fluid of embalming. It received teaching necessary near a specialized school and obtained a national diploma. It intervenes on the corpse after observation of the death and signature of the death certificate by a doctor. In 2005, there would be in France of about 700 thanatopracteurs, carrying out this care for approximately 20% of the deaths.

The initially male profession tends to be feminized but it should not be eluded the fact that this activity remains very physical.

Thanatopraxie and religious beliefs

the Islamic religion the interdict (except for the repatriation of a coffin towards certain countries).
the Christian religions (catholic, Protestant) accept the thanatopraxie.
the Jewish religion tolerates it, under certain conditions (only for the return of the coffin in Israel).
Buddhism does not accept it.

Acceptance or not acceptance according to the countries

According to AFIF, the injection of a formolized biocide would relate to approximately 3% of late of Europe. It is in the United Kingdom and in Metropolitan France that this practice primarily developed. It is rare in Germany, Spain, Ireland; quasi-non-existent in Austria, Greece, Italy, Malta, Portugal, Switzerland and prohibited or not used in the following countries: Scandinavian Belgium, Denmark, Holland, Luxembourg, Countries (except obligatory treatment to repatriate a coffin towards certain countries).

Formation

The trade requires an acceptance of death, and called upon many concepts such as the Anatomie, the Legal medicine, the Toxicologie, the Histologie, the Anthropologie, the Hygiène and safety, the funerary Réglementation, etc

There exists in France a national Diploma of thanatopraxie, and the practice of the trade requires a prefectoral enabling. A preliminary municipal authorization is obligatory with any work of conservation on the late body.

There are several schools, which did not standardize their programs of teaching (except the 150 hours of theory and 100 operations under the aegis of a graduate expert, defined in Council of State). The cards of safety, the toxicological and epidemiologic studies are not easily available, and are in particular not it for the pupils and trainees in formation, nor for the majority of the professionals.

Procedure

The care of conservation starts with stripping, the cleaning and the external disinfection of the late one. Then the Thanatopracteur which generally only operates injects a first product Antiseptique and Aseptique primarily containing Formol, at a rate of approximately 6 to 10 liters, per one of the many arteries of the human body (mainly: carotid primitive, humérale or femoral) that it made available beforehand by an incision. In the same time, it carries out a drainage physiological liquid of the body by puncture or flow via the venous system).

It drains also the gases which could accumulate in the body. It carries out the injection of the liquid of cavity. It sutures incisions and proceeds to the méchage of the natural openings. It cleans and arranges its instruments.

Depending on the state of decomposition, and the sought shelf life, it will use products more or less concentrated in Formaldéhyde (from 16 to 35%). With low dose, these Biocide S preserves fabrics, with strong amount, they fix them and harden.

The process is shown approximately an hour fifteen or one hour and half later, after the preparing of late and a last make-up by means of cosmetics adapted (make-up foundation, make-ups, powder) before its presentation in funeral home or the residence. It happens that one asks the expert to make a moulding of the face of the late one, and some of them are able to mould or reproduce parts of body disappeared in an accident or following the disease.

In addition to the effectiveness of the technique as for the conservation of the bodies; it makes it possible to the families to take care an asepticized body (approximately 90% of germs in less) decreasing by there the health hazards; and finally, by the image of the death which Thanatopraxie even reconditions recreates, would be this only using artifices, it facilitates the work of mourning considerably.

Dangers related to the trade

In addition to the risks sociopsychologic related to the contact with death and bodies sometimes strongly damaged, like with a relative loneliness and with the contact with the suffering of the close relations of late, the thanatopractor is in direct contact and permanent with bodies which can be those of serious patients.

The thanatopractor is exposed to 3 types of danger, which are added:

the toxicity of the products biocides used, and their relative volatility (methanol, carcinogenic formaldehyde, etc). In a part closed without ventilation, the situation is considered to be unacceptable from the point of view of the toxicological risk, as of the second injection. In the rooms of preparation the risk is less, but one needs a ventilation low and nonhigh, which is not always the case. One can finally wonder whether there are ecotoxicological impacts with the sending in the atmosphere of the aspired air;
the instruments prickles or cutting (can cause infections);
the biological fluids or excrétats which can contain infectious agents, with a higher nosocomial risk because of the fact that of many patients received long medical care, or were hospitalized in services at the nosocomial risk before their death. The HIV (AIDS), the virus of hepatitis C (the vaccination of the thanatopracteurs against hepatitis B is obligatory) even them Prions is dangers which can worry the experts, just as the Bacille of Koch of the Tuberculosis (who would have infected 15% of the thanatopracteurs in North America) or the virus grippal, in particular in a possible pre-pandemic context of the Avian flu. Once again the practice in room of preparation presents theoretically less risk, but requires to move the patient there.

The risk of exposure to these dangers is less in a room of preparation, but the operation must often be done at the inhabitant, in a case on two estimate the last studies in France. On average a care on two would be carried out without equipment equipped with controlled aspiration and/or allowing the protection of the expert.

There exist cards of prevention against certain risks, of which that of the exposure to formaldehyde

The thanatopraxie would be in France practiced with:

39% in the funerary rooms;
24% in the death chambers;
23% in the residence;
7% in the private clinics;
5% in the old people's homes;
2% in other places.

Thanatopraxie and Environnement

With a population resulting from the baby-boom which ages, and at a rate of 50 million foreseeable deaths in France for the decades which arrive, without same increasing speech of the risks of climatic catastrophes (floods, heat waves, drynesses, storms, increasing landslides of occurrence), of medical catastrophes (pandemic cf in particular risk of grippal type or other) the environmental problems, ecoepidemiologic and medical posed per death are not negligible.

The land pressure increases. It pushes the big cities to remove the grants in perpetuity for lack of place (on 10m ², one places only 4 coffins, against 200 ballot boxes (but the cremation has a considerable print ecological, from the consumption of wood or fossil resource which it implies, and because of pollution by the emissions). And of new problems arise.

In particular, the bodies of late often arrive at the Cimetière or the Crématorium after one long period of medical care, with many Plombage S (rich in mercury and metals toxic) and sometimes after having been embaumés.

Waste of care

Solids or liquids, they are noninert and dangerous products, known as DASRI ( Déchet of Activity of Care at the Infectious Risk ). They must be handled, labelled and transported like such.

They are subjected to European regulation translated in the right of the Member States, which implies their elimination by an approved die, defined in France by a decree of the Council of State.

Note: The gelled body fluids would pose less risk in the event of accident.

Case of prohibition for medical reasons (subject to modification)

In France, the conservation by injection of a formolized product is prohibited for the deaths with obstacle medico-legal, the industrial accidents or resulting from an occupational disease, and in the event of certain affections defined by the Decree of July 20th, 1998:

Coal;
Cholera;
viral hemorrhagic Fevers;
Viral hepatitis;
Disease of Creutzfeldt-Jakob;
Plague;
Rage;
HIV (AIDS);
Variola and others orthopoxviroses;
Any state septic engraves (on regulation of the attending physician or having drawn up the death certificate).

In France, a decree of the Council of State (November 8th, 1999) again authorized the thanatopraxie for:

serious septic states;
Hepatitises confirmed;
the disease of Creutzfeldt-Jakob.
For the SARS (severe acute respiratory Syndrome), the immediate beer setting was advised, and the disadvised care of conservation. In the event of pandemia grippale, induced for example by the Avian flu: the setting in coffin must be made without delay on the place of died or the transport of corpses (cold room, etc) any care of conservation being prohibited.

Conclusion

Few data are available on the practice of this activity in the world, and on the risks afférant there. The thanatopracteurs seem to underestimate the gravity of the dangers to which they are exposed and the decree which tallies the examination of thanatopraxie does not define the level of hygiene and safety relating to the care of conservation. The schools which form with these trades integrate these aspects in their formations, but without code of good practice, and minimal common base.

Any corpse should be regarded as at “the infectious risk”, by precaution, even if the death certificate does not mention a disease. It is recommended to the experts and to the families and close to respecting the precautions of use, in particular the ventilation of the part in which the care is made and where the late one will rest.

The studies of risks conclude that it would be preferable to prohibit the practice of this care in the residence (the formaldehyde concentration, found cancerogenic for the man, can be there twice higher than the limiting value) or out of the especially designed rooms of preparation. The protocol and the rooms of preparation can be improved.

External bonds

various Information, of the AFIF, on the subject
Forum on Thanatopraxie
risks related to the products biocides (Memory of engineer CNAM 2004)
Legislation, Places of formation in France
French association of funerary information

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